- What is global health?
Global health is an important new term, and an important new concept. In its seminal 1997 publication, America's Vital Interest in Global Health, The Institute of Medicine refers to global health as "health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions."
As the world becomes increasingly interdependent and the health of people influences the health of national economies, countries are increasingly recognizing the importance of "global health".
However, it is not just health problems that cross borders or are common to countries around the world; solutions to these problems can also cross borders and be shared among countries, regardless of level of development. All countries can both learn from other countries and also share their own experiences and information. An enlightened new definition of global health paints the picture of a two-way street: Shared problems, sharing solutions.
- Is "global health" different from "international health"?
YES, "global health" is different from "international health" in important ways.
The word "international" is literally defined in terms of national borders, whereas the word "global" encompasses the entire world. In many countries, "international health" is addressed quite separately from "domestic health" concerns within the country. "International health" can be limited to the area of foreign assistance; however, the 1997 IOM report notes that, at least for the United States, "foreign assistance can be only one small component of America's contribution to improving global health."
As it becomes increasingly clear that countries around the world share many of the same health problems, though perhaps of different magnitudes, the term "global health" becomes more aligned with current realities and more relevant to each country. The enlightened notion of global health as a two-way street allows us all to understand that countries around the world benefit from engaging globally in health - working together to share solutions to shared or common problems.
- What are some of the most important problems in global health today?
The landmark 1996 publication, The Global Burden of Disease, presented data from 1990 and data projections out to 2020 for three broad cause groups of health problems that, collectively, constitute the world's total disease burden. These are: Group 1, communicable, maternal, perinatal and nutritional conditions; Group 2, noncommunicable diseases; and Group 3, injuries. Within each of these broad groups are more specific conditions. The authors used a measure that incorporated the burden from both premature mortality and morbidity for non-fatal conditions (the DALY, or disability-adjusted life year). Data were presented for the world as a whole and by region, including analyses by sex and age group. Worldwide, Group 1 conditions accounted for 44% of the total disease burden in 1990; Group 2, 41%; and Group 3, 15%. The 15 leading individual problems, based on DALYs, were: (1) lower respiratory infections; (2) diarrheal diseases; (3) conditions arising during the perinatal period; (4) unipolar major depression; (5) ischemic heart disease; (6) cerebrovascular disease; (7) tuberculosis; (8) measles; (9) road traffic accidents; (10) congenital anomalies; (11) malaria; (12) chronic obstructive pulmonary disease; (13) falls; (14) iron-deficiency anemia; and (15) anemia. The World Health Organization (WHO) updates these data in their annual World Health Reports.
- How do health problems in the United States compare with those in other countries?
Interestingly, countries around the world share many of the same health problems, though these may differ substantially in magnitude and distribution, and some diseases are clearly more prevalent in some countries than in others. For example, according to The Global Burden of Disease, worldwide in 1990 the ten leading causes of death in developed regions were: (1) ischemic heart disease, (2) cerebrovascular disease, (3) cancers of the respiratory system, (4) lower respiratory infections, (5) chronic obstructive pulmonary disease, (6) colon and rectum cancers, (7) stomach cancer, (8) road traffic accidents, (9) suicide, and (10) diabetes mellitus. In developing regions, the ten leading causes of death in 1990 were: (1) lower respiratory infections, (2) ischemic heart disease, (3) cerebrovascular disease, (4) diarrheal diseases, (5) maternal mortality, (6) tuberculosis, (7) chronic obstructive pulmonary disease, (8) measles, (9) malaria, and (10) road traffic accidents. In the United States, the ten leading causes of death in 1998 were: (1) diseases of the heart, (2) cancers, (3) cerebrovascular diseases, (4) chronic obstructive pulmonary diseases, (5) injuries (including motor vehicle accidents and all other injuries), (6) pneumonia and influenza (i.e., lower respiratory infections), (7) diabetes mellitus, (8) suicide, (9) diseases of the kidney, and (10) chronic liver diseases. Thus, the at least eight of the ten leading causes of death in the U.S. are the same as found in developed regions, and five are the same as leading causes of death in developing regions.
- Who are the main U.S. Government agencies working in global health?
The Department of State is the lead institution for the conduct of U.S. diplomacy. This role is based on the role of the Secretary of State as the President's principal foreign policy advisor. The U.S. Agency for International Development is an independent federal agency responsible for U.S. foreign assistance; the agency takes overall foreign policy guidance from the Secretary of State. Health, population and nutrition represent one of six principal USAID areas of action for sustainable development. Some of the other U.S. Government agencies that are working in specific areas of health globally include the Department of Health and Human Services, the Peace Corps, the Department of Defense, and the Department of Agriculture.
- What does the Department of Health and Human Services do in global health?
HHS has a long history of active participation in specific global health priorities that are also important to the United States. One of the most important achievements in public health in the 20th Century was the eradication of smallpox. HHS provided important leadership and technical support the World Health Organization's global smallpox eradication campaign. HHS is currently helping to address selected global priorities as the global poliomyelitis eradication campaign, research training, food and product safety protection, emerging infectious diseases including HIV/AIDS, health and medical response to humanitarian emergencies and natural disasters, and others. HHS has active collaborations with key organizations such as the World Health Organization, the Pan American Health Organization, the World Bank, UNICEF , UN High Commissioner for Refugees, the UN Foundation, the Bill and Melinda Gates Foundation, CARE International, the Global Health Council, and others.
- What other major organizations and agencies work in global health?
As alluded to in previous sections, there are many important multilateral organizations, foundations, non-governmental organizations addressing health problems globally. Some of these include the World Health Organization, the Pan American Health Organization, the World Bank, UNICEF, UN High Commissioner for Refugees, the UN Foundation, the Bill and Melinda Gates Foundation, CARE International, the Global Health Council, and others. In addition, the governments of many other countries - especially their ministries of health and of foreign affairs - are also involved in important multilateral (worldwide) and bilateral (country to country) global health efforts.
- How much does the U.S. Government spend on global health?
The United States is by far the largest global health donor in actual dollar terms, and funding in some areas has increased steeply in recent years. For example within HHS, support for NIH international research and training increased from $202.8 million in Fiscal Year (FY) 1997 to $272.3 million in FY 1999; global health activities of CDC (especially oriented toward polio eradication and HIV/AIDS prevention) increased from $101.6 million in FY 1999 to $226.8 million in FY 2001 (FY 2001 is the current fiscal year, and runs from October 1, 2000-September 30, 2001). The greatest amount of federally funded global health work is through the U.S. Agency for International Development, with a total of $1.494 billion for FY 2001. More specifically with regard to global priority infectious diseases, the President's budget for FY 2002 includes an additional $212 million over the $480 already committed for HIV/AIDS, tuberculosis, and malaria alone. These funds will supply important research and health programs, prevent mother-to-child transmission of HIV and provide care of infected individuals in many of the most affected nations.
Even with these large commitments, the United States spends only 0.1 percent of its gross national product (GNP) on foreign assistance, a relatively low percentage compared with other developed countries. However, it is important to consider the indirect impact of the huge research and technical assistance activities that contribute to overall global health sponsored by the United States. Aside from direct foreign aid for health, these contributions serve the needs of developed and developing countries alike. Examples include training programs such as Fogarty's AIDS training program, which has trained about 2000 scientists from over 100 countries, CDC's Field Epidemiology Training Program and allied applied epidemiology training programs which have graduated approximately 1200 field epidemiologists in 25 countries, and the numerous US-based exchange programs supporting hundreds of scientists and students from abroad each year who return to their home countries to provide leadership in health. These benefits are difficult to quantify but are major contributions from the United States to global health that do not appear on foreign assistance budgets.
- How can I get involved in global health?
There are many ways, depending on your interests, skills and the level of effort you wish to invest. You can do anything from learning and talking about global health to devoting a career to it! And it doesn't matter if you are a citizen of the United States or of another country. Global health is important to us all. To begin with, you can learn more about global health by reading books or via the Internet. Some good publications are referenced on the Globalhealth homepage. You can also talk to your friends about global health: what it is, why it's important to you and to them, what the main problems are, what different organizations are doing to help solve these problems, etc. Once there are more people who understand all of this, there can be a stronger and more effective effort to really make a difference. If you are interested in a career in global health, you can think about studying medicine or public health to develop the skills you need. If you are a citizen of the United States, you can think about working or volunteering for U.S. Government efforts related to global health, including volunteering with the Peace Corps. Or, you might want to work with a non-governmental organization. Through any of the activities above, you can get involved and help make a difference in global health.
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